The radiological dating of injuries dating in the dc area
An appreciation of the differences between these types of injuries and the way they come to medical attention is important in understanding the pathophysiology of and expected timetable for fracture healing in cases of abuse.
A first important consideration is the nature of the clinical history available.
This is remarkable when one considers the important implications of these radiologic assessments.
This chapter attempts to provide some guidelines for dating fractures in infants and children in whom the diagnosis of physical maltreatment is considered.
At the same time, it is essential that suspicion is not raised inappropriately as the consequences for an innocent but accused parent or guardian are significant.
Over recent years, there have been a number of titles given to the constellation of injuries that are the result of the physical abuse of children.
The foundations of this current chapter were set down in the earlier editions of this text () by one of the current author’s (P. The current chapter builds on these observations with the incorporation of the recent literature and current concepts of fracture healing.
There is unilaminar (single-layered) SPNBF (white arrows).Radiologists may be the first clinical staff to suspect non-accidental injuries when confronted with a particular injury pattern.Knowledge of these is essential if the opportunity to save a child from future neglect is not to be missed.The so-called babygram (whereby the entire baby is imaged in one view) is not an acceptable substitute due to the overall lower quality that it produces; each anatomical region requires different radiographic exposures to accurately image.Lead markers should be used in skeletal surveys, and some institutions will repeat radiographs that do not have a lead marker within the primary field.
Traumatic periosteal injury can be seen up to 7 days post-injury (and therefore can be used for dating). Rib fractures are often missed, hence current practice is to repeat chest films in two weeks to observe for any healing fractures.